Clinical Review of Upper Gastrointestinal Hemorrhage

This paper reports a study on 246 cases of upper gastrointestinal(UGT) hemorrhage thatwere treated in the Department of Internal Medicine of the Ewha Womans University(Mokdong Hospital) over a period of 18 months from September of 1993 to May of 1995.

The results were as follows.

1) The causes of UGI hemorrhage were 156 peptic ulcer cases(63.4%) including 71 gastriculcer,82 duodenal ucler, and 3 marginal ulcer ; 44 esophageal varix cases(17.9%) ; 18 MalloryWeiss syndrome cases(7.3%) : 15 stomach cancer cases(6,1%) ; 7 acute gastric mucosal lesioncases(2.8%) ; 2 unknown causes ; and 4 other causes.

2) There were 204 males and 42 females(4.8 : 1). The age distribution was 51 in fifties(20.7%),49 in forties(19.9%), 44 in thirties(17.9%), 40 in sixties(16.2%), 24 in twenties(9.5%), and 24 in seventies(9.8%) resulting in 58.5% of the total cases from the thirties to fifties. Agedistribution of duodenal ulcer and Mallory-Weiss tear was younger than stomach cancer andgastric ucler(P<0.05).

3) The seasonal distribution showed spring 78 cases(31.7%), summer aS cases(10.1%), autum67 cases(27.2%), and winter 74 cases(30.1%) with peak incidence in spring.

4) The severity of UGI hemorrhage according to Palumbo's criteria was mild bleeding in 71 cases(28.8%), moderate bleeding in 115 cases(46.7%), and massive bleeding in 60 cases(24.4%)

5) The mean amount of transfusion for treatment was 4.2±2.4 unit for peptic ulcer, 3.2±1.8unit for varix, 5.9±3.1 unit for stomach cancer, and 0.3±0.2 unit for Mallory-Weiss tear.

6) Ninety one peptic ulcer was received endoscopic treatment(58.4%). Among them, therewere 13 rebleeding cases(14.3%) and 9 cases required surgical opertaion(9.8%). Thirly fivevarix cases received endoscopic treatment(79.5%) and there were 3 rebleeding cases(8.6%).

7) The motality was 4.1%(10 cases). The main causes of deaths were 1 sepsis case, 3 hepaticcoma cases, and 6 hepatoma intraperitoneal rupture cases.