TÜRKAY AKBAŞ, Neşe İMERYÜZ, Aysun BOZBAŞ, Nurdan TÖZÜN

Analysis of the patients admitted to Marmara University Hospital with non-variceal upper gastrointestinal bleeding

Amaç: Endoskopik tedavi çağında, varis dışı üst gastrointestinal kanama hala önemli bir mortalite ve morbidite nedenidir. Bu çalışmanın amacı, bir eğitim hastanesine varis dışı üst gastrointestinal kanamayla başvuran hastaları klinik ve endoskopik özellikleri açısından araştırmaktır. Metod: Varis dışı üst gastrointestinal kanamayla 1996-2001 tarihleri arasında başvuran 250 hasta retrospektif olarak incelendi. Bulgular: Hastaların ortalama yaşı 59 olup %34.4'ü kadındı. Hastaların %59.6'sında aspirin/non-steroidal anti-inflamatuar ilaç (NSAİİ), %2.8'inde steroid ve %9.6'inde varfarin kullanımı vardı. Vakaların %31.8'i daha önce de gastrointestinal sistem kanaması geçirmişti. En sık görülen lezyon peptik ülserdi (%49.2), bunu duodenal ve gastrik erozyonlar (%19.2) ile mide tümörleri (% 10.8) izliyordu. Lezyonlar mide (%40), duodenum (%33.6), gastrojejunal bileşke (%4.4) ve özofagus (% 4.4) yerleşimliydi. H. pylori varlığı 48 olguda araştırıldı, bunların %79.2'sinde pozitif bulundu. Aktif kanama belirtisi olan 33 hastaya endoskopik tedavi uygulandı. Endoskopik tedavisi başarısız olan 3 hastayla beraber 7 hastaya (%2.8) cerrahi işlem uygulandı. Hastaların 6'sı (%2.4) kaybedildi. Sonuç: Çalışmamızda en önemli kanama nedeni peptik ülserdi. Hastaların büyük bir çoğunluğunda kanamaya neden olacak en az bir risk faktörü vardı (H. pilori veya ilaç kullanımı). Kanama nedenleri kolay tedavi edilebildiğinden, hasta grubumuzda endoskopik ve cerrahi tedavi oranı ile mortalite düşük bulundu.

Marmara Üniversitesi Hastanesine varis dışı üst gastrointestinal kanama ile başvuran hastaların değerlendirilmesi

Objective: Non-variceal upper gastrointestinal bleeding (NVUGIB) remains an important cause of morbidity and mortality despite the availability of advanced endoscopic techniques for haemostasis. We have described clinical and endoscopic features of the patients with NVUGIB in a teaching hospital. Method: Two hundred and fifty patients admitted between 1996 and 2001 with acute NVUGIB have been evaluated retrospectively. Results: Mean age was 59 and 34.4% were women. Ingestion of aspirin/non-steroidal anti-inflammatory drugs, steroid or warfarin during the previous week was reported for 59.6%, 2.8%, 9.6% of the patients, respectively. Previous upper gastrointestinal bleeding was reported for 31.8% of the patients. The leading cause of bleeding was peptic ulcer (49.2%), followed by erosions (19.2%) and stomach tumors (10.8%). Lesions were located in the stomach (40%), duodenum (33.6%), at the gastrojejunostomy line (4.4%) and esophagus (4.4%). H. pyloric region was positive in 79.2% of the 48 patients investigated. Endoscopic treatment was applied to 33 patients. Seven cases (2.8%) including 3 which had failed endoscopic therapy had a surgical intervention. Six patients (2.4%) died. Conclusion: The main cause of bleeding was peptic ulcer. The majority of patients had either an H. pylori infection or an offending drug use. Since the etiology of bleeding was amenable to treatment, the rate of endoscopic and surgical treatment and mortality were low in our patients.

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