Dilek BAHADIR (), Mehmet Yalniz (), Ulvi Demirel (), Cem AYGÜN (), İbrahim Halil BAHÇECİOĞLU ()

Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri

Giriş ve Amaç:Varis dışı üst gastrointestinal sistem kanaması sık karşılaşılan önemli acillerden biridir. Bu çalışmada varis dışı üst gastrointestinal sistem kanamalı hastalarda demografik ve klinik özelliklerin de¤erlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2005-2010 yılları arasında Varis dışı üst gastrointestinal sistem kanaması nedeniyle endoskopi yapılarak izlenmiş olan toplam 330 hasta demografik özellikleri, etyoloji, risk faktörleri, tedavi ve mortalite yönünden retrospektif incelendi. Bulgular: 228'i (%69.1) erkek, 102'si (%30.9) kadın olup yaş ortalaması 59.9 (17-99) idi. Hastaların 84'ü (%25.5) sigara, 12'si (%7) alkol, 292'si (%88.5) ilaç; (148'i (%44.8) nonste-roid anti-inşamatuvar ilaç, 113'ü (%34.2) aspirin) kullanıyordu. En sık hi-pertansiyon (n=96, %29.1) olmak üzere eşlik eden hastalıklar mevcuttu. En-doskopi hastaların 156'sına (%47.3) ilk 12 saatte, 117'sine (%35.5) ilk 12-24 saatte, 57'sine (%17.3) 24 saat sonrasında yapılmıştır. 84 (%25.5) hastaya en sık (%88.1) adrenalin enjeksiyonu olmak üzere endoskopik tedavi uygulan-mıştır. Hastaların 122'sine (%37) üreaz testi yapılmış, 107'sinde (%87) Heli-kobakter pozitif olarak bulunmuş. ‹lk 12 saatte 0.81±1.0, totalde 1.8±2.1 eritrosit süspansiyonu verilmiştir. En sık rastlanan kanama nedenleri; 257'de (%77.9) peptik ülser, 119'da (%36.1) mide ülseri, 138'de (%41.8) duodenal ülser) ve erozif gastrittir (n=203, %61.5). Rockall skorlamasına göre 61 (%18.5) hasta düşük risk, 260 (%78.8) hasta orta risk ve 9 (%2.7) hasta yük-sek riskliydi. Forrest evrelemesine göre ço¤u evre 3 ülsere sahipti (n=153, %40.9). Evre 2B ülserlerse mortaliteyle pozitif koreleydi. 7 hastaya (%2.1) cerrahi tedavi gerekti, 6'sında (%1.8) ölüm gerçekleşti. Sonuç: Varis dışı üst gastrointestinal kanama erkeklerde ve yaşlılarda daha sık görülmekte olup en sık nedeni peptik ülserdir. Yarısından fazlasında nonsteroid anti-inşamatuvar ilaç ve aspirin kullanımı risk faktörü olarak saptandı. Mortalite, cerrahi ve eritrosit süspansiyon replasmanı ihtiyacı oldukça düşük saptandı. Bunun ne-deni erken (ilk 24 saat) endoskopik inceleme ve müdahalenin yüksek oran-da olmasından kaynaklanabilir.

Anahtar Kelimeler:

Varis dışı üst gastrointestinal kanama, etyoloji, endoskopi

Demographical and clinical characteristics of the patients with non-variceal upper gastrointestinal bleeding

Background and Aims: Non-variceal upper gastrointestinal bleeding (NVUGB) is one of the most frequent emergencies. The aim of the present study was to determine the demographic and clinical features of NVUGB pa-tients. Materials and methods: Patients with NVUGB admitted between 2005-2010 years examined with endoscopy were evaluated retrospectively in terms of demographical characteristics, etiological risk factors, treatment mo-dalities and mortality.Results: Mean age of 228 (%77) male and 120 (%23) female was 59, 9 (17-99). 84 (%25.5) of the patients were smoking, 12 (%7) were drinking alcohol, 292 (%88.5) were using drug (148/292 (%44.8) non-steroidal anti-inflammatory drug (NSAIID), 113/292 (%34.2) acetyl salicylic acid. Hypertension (n=96, %29.1) was the most common comorbidty. En-doscopic procedure time: 156 (%47.3) in first 12 hours, 117 (%35.5) in first 12-24 hours, and 57 (%17.3) after 24 hours. Endoscopic therapy was perfor-med in 84 (%25.5) of the patients. Adrenalin injection was the most frequent treatment modality. Urease test was performed in 122 (%37) of the patients and 107 (%87) of this was helicobacter pylori positive. Patients were given 0.81±1.0 erythrocyte suspension at the first 12 hours, totally 1.8±2.1 eryt-hrocyte suspension were given.Conclusion: The most common causes of bleeeding were; 257 (%77.9) peptic ulcer, 119 (% 36.1) gastric ulcer, 203 (%61.5) and erosive gastritis. According to rockall score 61 (%18.5) patients had low risk, 260 (%78.8) patients had moderate risk and 9 (%2.7) patients had high risk. According to forrest score most of the patients had stage 3 ul-cer (n=153, %40.9) and stage 2B correlated with mortality positivley. Seven (%2.1) patients required surgical treatment and six (%1.8) patients died. Pep-tic ulcer was the most common cause of non-variciel upper gastrointestinal bleeding. Bleeding is seen more commonly in males and elders. Acetyl salicy-lic acid and NSAIID were found as risk factors in over half of the bleeding pa-tients. Rate of mortality, surgery and transfusion of erythrocyte suspension was very low. This might be related to the high rate of early endoscopy and endoscopical therapy.

Keywords:

Non-variciel upper gastrointestinal system bleeding, etiology, endoscopy,

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